Individual
MELANIE CODERRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2850 S WABASH AVE, CHICAGO, IL 60616-2955
(312) 842-4600
Mailing address
2850 S WABASH AVE STE 100, CHICAGO, IL 60616-2491
(312) 842-4600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.010186RX
OH
363AS0400X
Surgical Physician Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.006251
ILLINOIS LICENSE
IL
Enumeration date
06/15/2017
Last updated
05/13/2026
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